Provider Demographics
NPI:1801412390
Name:MARTIN, KIMBERLY ALBERTA (MHC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALBERTA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 CRESCENT ST FL 1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3108
Mailing Address - Country:US
Mailing Address - Phone:347-870-2460
Mailing Address - Fax:
Practice Address - Street 1:2368 CRESCENT ST FL 1
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-3108
Practice Address - Country:US
Practice Address - Phone:347-870-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health